Meridian Joint School District No. 2

SECONDARY SCHOOLS REQUEST FOR TRANSFER OF RECORDS

TO:     Releasing School or Agency                  

            Address           

            City                     State       Zip       

 RE:     Student Name      Birthdate            Grade 9th 10th 11th 12th

 Receiving School:

             Central Academy

            6075 N. Locust Grove

            Meridian,  ID  83646

            (208) 855-4325, FX (208) 855-4324

      q           Permanent Records / Official Transcripts (birth certificates, grades, standardized     

                 scores, awards, attendance and class standing, and records of disciplinary action.)

q           Health File (all health information and immunization.) 

q            Special Services Assessments (including Individualized Educational Program, 504 Plan, psychological, speech, language, hearing/physical therapy, occupational therapy, audiological casework, medical, vocational, etc.). 

q             Withdrawal Grades 

q             Other: __________________________________________________________

 I authorize the release of records to the Meridian School District.

__________________________________         ______________________________

Parent / Guardian Signature                                                  Date

According to the Final Regulations – Family Educational Rights and Privacy Act (Buckely Amendment) dated June 17, 1976, it is no longer necessary to obtain written consent to release records to other educational agencies.

__________________________________          _____________________________

School Official                                                                      Date